Top 10 Myths and Facts About ADHD

1)      Myth: Nobody had ADHD when I was a kid! Now everybody has it. It’s over diagnosed.

Facts: ADHD has been a defined medical condition since the 1700s. It is no more common in kids or teenagers now than it was 30 years ago. However, it is now more likely to be recognized and correctly diagnosed and treated, particularly in girls. 

-          ADHD was first characterized in a medical textbook in 1775 by German physician Melchior Adam Weikard.

-          In 1917, Spanish neurologist and psychiatrist Gonzalo Rodriguez-Lafora hypothesized that ADHD symptoms in children were caused by a genetic brain disorder.

-          In 1937, US physician Charles Bradley found that amphetamine improved ADHD symptoms.

-          There has been no increase in prevalence of ADHD in children or adolescents over the past 30 years.

 

2)      Myth: People with ADHD could concentrate just as well as anyone else if they wanted to. They just need to try harder!

Facts:  ADHD is a neurodevelopmental disorder. This means the brain develops differently in utero and people are born with the condition. ADHD is caused by a combination of genetics and in-utero exposures, such as maternal use of certain medications, maternal smoking, and maternal exposure to environmental toxins. Some childhood exposures, such as pesticides, lead, certain infections, and traumatic experiences worsen symptoms and make it more likely that ADHD will be diagnosed. ADHD causes measurable differences in brain structure and function that don’t just go away when people try harder!

 

3)      Myth: ADHD is no big deal! It’s a lot less serious than other mental illnesses.

Facts: ADHD is a very big deal. Having ADHD increases risks for other psychiatric disorders, medical disorders, injuries, and accidents. Untreated ADHD has negative effects on education, employment, and achievement, increasing risk of unemployment, substance use, criminality, criminal victimization, and teen pregnancy. All of these factors lead to significantly decreased quality of life for people with ADHD and their families. Here are some statistics:

-          People with unmedicated ADHD have 20-50% higher risk of obesity, 1.7-3x higher risk of Type II Diabetes, and 3x higher risk of contracting an STD.

-          People with ADHD have a higher risk for cardiovascular disease, particularly cardiac arrest, hemorrhagic stroke, and peripheral vascular disease/arteriosclerosis, even when controlling for use of ADHD medications, other psychotropic medications, sex, age, smoking, obesity, DMII, dyslipidemia, and sleep problems.

-          People with ADHD have an elevated risk for depression, bipolar disorder, autism spectrum disorders, anxiety disorders, oppositional defiant disorder, conduct disorder, and eating disorders.

-          People with ADHD are 3x as likely to have low educational achievement, 8x as likely to have been in Special Education; and 2x as likely to drop out of school before age 16, and they are 40% more likely to be unemployed, even after adjusting for socioeconomic confounders and other psychiatric conditions.

-        People with ADHD have twice the rate of death by homicide, and a 30% greater rate of death from unintentional injury.

-        They are 23% more likely to be involved in vehicular crashes.

-        They are three times as likely to have had three or more concussions.

-        Children with ADHD have a 3x greater risk of poisoning.

-        They are more than 3x more likely to develop drug use disorders after adjusting for sex and parental education.

-        They are more than 2x as likely to be convicted of criminal offenses and were three times as likely to be incarcerated.

-        They are 2.7 times more likely to be victims of violent crimes in general, and 3.7 times as likely to be victims of sexual crimes.

-        People with ADHD are 65% more likely to be victims of dating violence.

-        They are more likely to have teen pregnancies, and children of teen mothers are more likely to have ADHD.

-        People with ADHD have 2-4x the average rate of suicide attempts; 6x rate of repeated attempts; 6x rate of completed suicide; and 10x higher rate of attempts and deaths if ADHD is comorbid with another psychiatric disorder.

 

4)      Myth: Everyone has ADHD according to those screening tests!

Facts: Commonly used screening tests have very good sensitivity and specificity, meaning they are very good at identifying people who DO have ADHD, and very good at ruling out people who DO NOT have ADHD. Screening tests also show strong correlation with clinician diagnostic evaluations. In situations where the diagnosis is not clear, neurocognitive testing can help clarify the diagnosis.

-        Adult ADHD Self-Report Scale 91% Sensitivity (correctly identifies 91% of people with ADHD) and 96% Specificity (correctly rules out 96% of people who do not have ADHD).

-        Correlation between Scales and Clinician diagnosis is 0.69 in adults and 0.74 in kids (0.4 is good).

-        Computerized neurocognitive testing can objectively show the presence or absence of deficits that are characteristic of ADHD, such as deficits in attention, impulse control, and working memory, and can indicate if a patient is putting full effort into the test.

 

5)      Myth: Really smart people can’t have ADHD! You had to have done poorly in school to have it.

Facts: People often think that if a person has a high IQ, or did well in school, they can’t possibly have ADHD.  However, ADHD has nothing to do with IQ and affects people of low, average, and high IQ, causing the same health and social risks in all of these groups. People with high IQs can typically do well in school until they reach college or graduate school, when the quantity of work often becomes more than they can easily manage and they may begin to struggle academically. Even if they make good grades, ADHD can still cause problems with behavior, difficulty in friendships, and decreased quality of life.

-        A study in people with ADHD found no difference in median age at which ADHD criteria were met, rates of learning disorders, psychiatric disorders, substance abuse, or rates of stimulant treatment in people with low, average, or high IQ.

-        Bill Gates, founder of Microsoft, and Katherine Ellison, Pulitzer winning international journalist, both have stated publicly that they have ADHD, and they’re pretty smart!

 

6)      Myth: ADHD medications don’t really work!

Facts: Studies show that ADHD medications improve ADHD symptoms, performance on cognitive tests, and educational and career attainment, and dramatically reduce risks of accidents and injuries, other psychiatric comorbidities, social problems associated with ADHD, and suicidality. Here are some of the beneficial effects of ADHD medication demonstrated in the studies:

-        Treatment with medication resulted in moderate to large improvements in teacher-rated behavior.

-        People with ADHD had higher test scores during periods when taking medication vs non-medicated periods.

-        Taking medication for 3 months produced more than 9-point gain in grade point sum.

-        Treatment with medication is associated with 67% increase in the probability of completing upper secondary school.

-        People with ADHD who take medication have the same risk for obesity as the general population (as opposed to 20-50% higher risk without meds).

-        Treatment with stimulants reduced anxiety by 14% vs placebo.

-        ADHD medication reduced risk for depression more than 40%, and risk decreased with the duration of ADHD medication use.

-        Stimulant treatment led to small-to-moderate reductions in emotional dysregulation.

-        Stimulant treatment was highly effective in reducing aggression, oppositional behavior, and conduct problems in youth with ADHD, ODD, and conduct disorder, as measured by teachers.

-        Stimulant treatment reduced suicide related events by 20% during treatment vs untreated periods.

-        Stimulant treatment for 3-6 months reduced risk for suicide by 60%, and treatment for more than 6 months reduced risk by 70%.

-        Crime rates in adulthood were 30–40% lower when taking ADHD medication.

-        Stimulant treatment was associated with a decrease in rates of all injuries, and a lower rate of all-cause mortality.

-        During treatment, traumatic brain injuries were reduced by 70%, and the risk of vehicle crashes was 38% lower in males and 42% lower in females.

-        Half of burn injuries could have been prevented by taking medication. Treatment for < 90 days resulted in a 30% lower risk of burn injuries, and treatment for 90 days or more reduced risk 57%.

-        Treatment was associated with a 30%-40% reduction in STDs among males.

-        Long-term treatment was associated with a 30% decrease in teenage pregnancy.

 

7)      Myth: Therapy and supplements are just as effective for ADHD as medication.

Facts: Therapy and supplements do help with ADHD symptoms, but not as much as medication. However, the combination of medication AND therapy is better than either one by itself. Studies show:

-        Therapy causes small to moderate improvements in ADHD symptoms, but ADHD medications cause moderate to large improvements in ADHD symptoms.  

-        Therapy does help with the emotional problems associated with ADHD (depression, anxiety, rejection sensitive dysphoria, relationship problems, work problems, etc.).

-        The highest proportion of improved outcomes (83%) results from combination treatment with both medication and therapy.

 

8)      Myth: Everyone does better when they take stimulants. They give people an unfair advantage!

Facts: People who do not have ADHD and take stimulants do NOT do better on cognitive tests and do NOT get better grades in either the short or long term. In fact, they do worse. Only people who have ADHD perform better when they take stimulant medication.

-          Studies of college students who do not have ADHD and engage in non-medical use of stimulants showed no benefit over their peers and non-medical use did not increase GPA either in the short term (in one semester) or in the long term (over multiple years). In fact, non-medical use caused a decline in attendance and grades.

-          Studies showed that people who do not have ADHD who were given stimulants felt stimulated on them, but did not show any improvement in cognitive testing results.

 

9)      Myth: Stimulants are dangerous!

Facts: “Currently there is no (conclusive) evidence of significant long-term risks from using stimulants” –Updated European Consensus Statement on Diagnosis and Treatment of ADHD. However, some studies did show some increased risks:

-        Mania: A pharmaco-epidemiological study found that methylphenidate mono-therapy in patients with bipolar disorder increased the risk of switch to a manic episode (hazard ratio 6.7). However, when combined with a mood stabilizer, treatment with methylphenidate reduced the risk of mania (hazard ratio 0.6). This supports the current recommendation to treat ADHD in patients with bipolar disorder with stimulants, so long as they are also taking mood stabilizers.

-        Psychosis: Treatment with methylphenidate does not increase risk, in fact incidence of psychosis was 36% lower in pts taking methylphenidate. Amphetamines may cause a very slightly elevated risk (0.21% higher in one study) of psychosis in the first 60 days of treatment, but studies are inconsistent.

-        Cardiovascular risks: A meta-analysis of five studies with over 43,000 children and adolescents found no significant difference in adverse cardiac events between methylphenidate and atomoxetine, and a meta-analysis of three studies with 775 adults found no significant difference in adverse cardiac events between methylphenidate and placebo. A meta-analysis covering people of all ages reported methylphenidate was not associated with a higher risk of all-cause death (3 studies, over 1.4 million people), heart attack or stroke (3 studies, over half a million people). A study using Danish national registers followed over 700,000 individuals for an average period of almost a decade. Cardiovascular events were rare. In the entire general population of 714,258 subjects (6,767,982 person-years), a total of 5734 individuals (0.8%) had a cardiovascular event (84 events per 100,000 person-years). There was an increased risk of any cardiovascular event (primarily hypertension) in stimulant users compared with non-users in the total population, with an adjusted HR of 1.83 (95% CI 1.10–3.04), so roughly 150 events per 100,000 person-years.  Among children with ADHD (n = 8,300) we identified 111 cardiovascular events (1.3%)  (170 events per 100,000 person-years). In children with ADHD, stimulant use versus non-use was associated with an increased hazard for a cardiovascular event (adjusted HR = 2.34), so approximately 400 events per 100,000 person-years.

 

10)   Myth: Adderall is a gateway drug!

Facts: People often think that taking appropriately prescribed and administered stimulants for ADHD will cause them to get addicted or that use of stimulants will lead them to abuse other drugs. This is not true. Here’s what the research shows:

-        People with ADHD rarely get addicted to stimulants if they are prescribed appropriately, unless they take more than prescribed, or snort, smoke or inject their medication. Only 2.5% of patients taking stimulants develop stimulant use disorder (2-3 pts out of 100). Only 0.5% of people taking stimulants snort them (1 out of 200 patients taking stimulants), 0.15% inject (less than 1 out of 500 patients), and 0.075% smoke them (less than 1 out of 1000 patients). Prescribers can minimize risk of misuse and abuse by prescribing appropriate doses, completing a yearly drug screen, and monitoring the state prescription registry for evidence of early refills, provider shopping, and/or multiple controlled prescriptions.

-        People who take stimulants are actually less likely to start using illicit drugs than people who do not take them. A meta-analysis found that stimulants did not increase the risk for abuse of or dependence on alcohol (11 studies, over 1,300 participants), nicotine (6 studies, 884 participants), cocaine (7 studies, 950 participants), or cannabis (9 studies, over 1,100 participants). Another study investigated the association between use of prescription stimulant medication for ADHD in 2006 and substance abuse during 2009 among 38,753 people born between 1960 and 1998 and diagnosed with ADHD. After controlling for relevant confounding variables, it found a greater than 30% reduction in indicators of substance abuse among those prescribed stimulants. The longer the duration of medication, the lower the rate of substance abuse.

-        However, people with active substance abuse problems, particularly abuse of stimulants, should be in a substance abuse treatment program before starting stimulant treatment for ADHD.

-        People who have a remote history of substance abuse should be able to safely use prescribed stimulants, with close monitoring by their provider for signs of misuse or abuse.

 

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